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Approximately 1 million children and adults were living with HIV in 2001 in the WHO European Region, and estimations suggest that this number increased to 2.3 million people in 2010 and is still rising. Alarmingly, around half of those people do not know that they are infected. Despite the progress in achieving universal access to HIV prevention, treatment, care and support across the Region over the last decade, the fight against HIV epidemic still faces many challenges.

• Because of low access to and uptake of HIV testing and counselling, especially among the populations most at risk of infection and transmission, all HIV cases in Europe are not diagnosed. No country knows exactly how many infected people it has within its borders, making it difficult for the health system to offer appropriate scale of medical services, including medical treatment and care.
• For HIV combination therapy to work, it is best started at a time when the patient is still relatively healthy. Unfortunately, many Europeans with HIV start treatment too late and already show signs of widespread immune system damage, leading to excess mortality among people infected with HIV/AIDS in western Europe.
• Access to life-saving antiretroviral therapy is inadequate in a number of European countries; as a result, patients who need the therapy often do not receive it. Lack of access to treatment reduces the incentive to get tested, as does fear of discrimination and stigmatization. In eastern Europe and central Asia, only 23% of those believed to need antiretroviral treatment were receiving it in 2010.
• Tuberculosis (TB) remains widespread in eastern Europe. The risk of developing TB is far greater for people living with HIV if the infection is not treated. For this reason, the incidence of TB will likely continue to rise in eastern Europe.
• More than half of the estimated 2.3 million people living with HIV are also chronically infected with the hepatitis C virus (HCV). The people most at risk of HIV/HCV coinfection are people who inject drugs and men who have sex with men. Coinfection can lead to life-threatening liver failure. Hepatitis is difficult to treat, and this situation is likely to lead to tens of thousands of unnecessary deaths in the years to come.

WHO/Europe works to address these challenges. In September 2011, 53 Member States of the European Region endorsed an Action Plan calling for urgent action by the WHO Regional Office for Europe, the Member States and other stakeholders to address the growing HIV epidemic in the Region:

• The vision for the European Region is zero new HIV infections, zero AIDS-related deaths and zero discrimination in a world in which people living with HIV are able to live long, healthy lives.
• The goals for the European Region are, by 2015: to immediately halt and reverse the spread of HIV in Europe; to achieve universal access to comprehensive HIV prevention, treatment, care and support; and to contribute to the attainment of Millennium Development Goal 6 and other health-related Millennium Development Goals (3, 4, 5 and 8).
• The Action Plan proposes areas of intervention within the framework established by the UNAIDS strategy for 2011–2015 and the WHO global health sector strategy on HIV/AIDS for 2011–2015.
• The Action Plan is anchored in the guiding principles of: equity in health; community participation; human rights; evidence-informed policies and ethical public health approaches.
• The Action Plan is based on the four strategic directions of the WHO global strategy, with proposals for implementation that reflect the European context and address the priorities of the Region: 1.Optimizing HIV prevention, diagnosis, treatment, care and support outcomes; 2. Leveraging broader health outcomes through HIV response; 3. Building strong and sustainable health systems; 4. Reducing vulnerability and the structural barriers to accessing services.
• The primary audience for the European Action Plan for HIV/AIDS 2012–2015 is the national authorities in the WHO European Region responsible for HIV diagnosis, prevention, treatment, care and support, including health ministries and other government bodies responsible for health.